Provider Demographics
NPI:1285200238
Name:MUNOZ, JULIET SILLICY (CHW)
Entity Type:Individual
Prefix:
First Name:JULIET
Middle Name:SILLICY
Last Name:MUNOZ
Suffix:
Gender:F
Credentials:CHW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 SE 182ND AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97233-5692
Mailing Address - Country:US
Mailing Address - Phone:503-988-5558
Mailing Address - Fax:503-988-5660
Practice Address - Street 1:2020 SE 182ND AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97233-5692
Practice Address - Country:US
Practice Address - Phone:503-988-5558
Practice Address - Fax:503-988-5660
Is Sole Proprietor?:No
Enumeration Date:2021-06-01
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORTHW000104637172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORTHW000104637OtherOREGON HEALTH AUTHORITY